scholarly journals Early clinical experience with a monoclonal antibody against the calcitonin gene-related peptide receptor in adolescents with migraine: A case series

2020 ◽  
Vol 29 (3) ◽  
pp. 212-214
Author(s):  
Yi Jing Zhao ◽  
King-Hee Ho ◽  
Pei Shieen Wong
Keyword(s):  
Monoclonal Antibody ◽  
Case Series ◽  
Calcitonin Gene Related Peptide ◽  
New Class ◽  
Related Peptide ◽  
Pediatric Migraine ◽  
Calcitonin Gene ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Favorable Safety

Management of migraine in adolescents poses a great challenge, as many of the approved pharmacological migraine preventive agents have age restrictions. Following favorable safety and efficacy reports of the new class agent calcitonin gene-related peptide (CGRP) monoclonal antibody for use in migraine prevention, there is growing interest in its application in pediatric migraine. We present here a case series detailing our experience of using erenumab, a CGRP monoclonal antibody, in six adolescent patients. Two patients had a reduction of at least 50% in the mean number of monthly migraine days, one patient reported subjective improvement, while three patients did not respond to the first dose of erenumab and discontinued treatment. One patient reported constipation associated with erenumab use. We speculate that CGRP monoclonal antibody could potentially be a viable option in adolescent patients with migraine. Further evidences that support efficacy and safety of erenumab in this group is needed.

scholarly journals Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

2020 ◽  
Author(s):  
Andreas Yiangou ◽  
James Mitchell ◽  
Vivek Vijay ◽  
Olivia Grech ◽  
Edward Bilton ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Case Series ◽  
Calcitonin Gene Related Peptide ◽  
Dominant Factor ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Calcitonin Gene

Abstract BackgroundHeadache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need.Case seriesWe report a series of seven patients in whom headaches were the presenting feature of IIH the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilledema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab.ConclusionsThose with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH.

scholarly journals Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Andreas Yiangou ◽  
James L. Mitchell ◽  
Vivek Vijay ◽  
Olivia Grech ◽  
Edward Bilton ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Case Series ◽  
Calcitonin Gene Related Peptide ◽  
Dominant Factor ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Calcitonin Gene

Abstract Background Headache is the dominant factor for quality of life related disability in idiopathic intracranial hypertension (IIH) and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet clinical need. Case series We report a series of seven patients in whom headaches were the presenting feature of IIH and the headaches had migraine-like characteristics, as is typical in many IIH patients. Papilloedema settled (ocular remission) but headaches continued. These headaches responded markedly to erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Of note, there was a recurrence of raised ICP, as evidenced by a return of the papilloedema, however the headaches did not recur whilst treated with erenumab. Conclusions Those with prior IIH who have their headaches successfully treated with CGRP therapy, should remain under close ocular surveillance (particularly when weight gain is evident) as papilloedema can re-occur in the absence of headache. These cases may suggest that CGRP could be a mechanistic driver for headache in patients with active IIH.

scholarly journals Calcitonin gene related peptide monoclonal antibody treats headache in patients with active idiopathic intracranial hypertension

2020 ◽  
Author(s):  
Andreas Yiangou ◽  
James Mitchell ◽  
Vivek Vijay ◽  
Olivia Grech ◽  
Edward Bilton ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Unmet Need ◽  
Case Series ◽  
Calcitonin Gene Related Peptide ◽  
Evidence Based ◽  
Cgrp Receptor ◽  
Related Peptide ◽  
Calcitonin Gene

Abstract BackgroundThe mechanisms driving headache in Idiopathic Intracranial Hypertension (IIH) are not fully understood. Headache is the dominant driver for disability and typically has migraine-like characteristics. There are currently no evidence-based therapeutics for headache in IIH, and consequently this is an important unmet need.Case seriesWe report seven patients with confirmed IIH who initially presented with increased headache driven by raised intracranial pressure (ICP). The headaches had migraine-like characteristics which persisted despite resolution of papilloedema (ocular remission). These headaches responded markedly to Erenumab, a monoclonal antibody targeted against the calcitonin gene related peptide (CGRP) receptor. Importantly, there was a recurrence of raised ICP and papilloedema, however headaches did not recur whilst treated with Erenumab.ConclusionsThese cases suggest that CGRP could be a mechanistic driver for headache in patients with active IIH. Clinical trials evaluating safety and efficacy of CGRP monoclonal antibodies in active IIH would be of interest.

Galcanezumab for the prevention of migraine

2020 ◽  
Author(s):  
Lindsay M Frerichs ◽  
Deborah I Friedman
Keyword(s):  
Monoclonal Antibody ◽  
Clinical Efficacy ◽  
Preventive Treatment ◽  
Calcitonin Gene Related Peptide ◽  
Efficacy And Safety ◽  
Related Peptide ◽  
Calcitonin Gene

Migraine is a common and disabling disorder affecting approximately 1.02 billion people worldwide. Calcitonin gene-related peptide (CGRP) has been identified as playing an important role in the pathophysiology of migraine and several migraine-specific therapies targeting the CGRP ligand or its receptor have been approved since 2018 for the acute and preventive treatment of migraine. This review focuses on the pharmacology, clinical efficacy and safety/tolerability of galcanezumab, an anti-CGRP monoclonal antibody approved for the prevention of migraine.

scholarly journals Enhanced post-traumatic headache-like behaviors and diminished contribution of peripheral CGRP in female rats following a mild closed head injury

Cephalalgia ◽  
2020 ◽  
Vol 40 (7) ◽  
pp. 748-760 ◽  
Author(s):  
Dara Bree ◽  
Kimberly Mackenzie ◽  
Jennifer Stratton ◽  
Dan Levy
Keyword(s):  
Monoclonal Antibody ◽  
Head Injury ◽  
Closed Head Injury ◽  
Calcitonin Gene Related Peptide ◽  
Female Rats ◽  
Related Peptide ◽  
Increased Risk ◽  
Calcitonin Gene ◽  
Closed Head ◽  
Post Traumatic

Introduction Females are thought to have increased risk of developing post-traumatic headache following a traumatic head injury or concussion. However, the processes underlying this susceptibility remain unclear. We previously demonstrated the development of post-traumatic headache-like pain behaviors in a male rat model of mild closed head injury, along with the ability of sumatriptan and an anti-calcitonin-gene-related peptide monoclonal antibody to ameliorate these behaviors. Here, we conducted a follow-up study to explore the development of post-traumatic headache-like behaviors and the effectiveness of these headache therapies in females subjected to the same head trauma protocol. Methods Adult female Sprague Dawley rats were subjected to a mild closed head injury using a weight-drop device (n = 126), or to a sham procedure (n = 28). Characterization of headache and pain related behaviors included assessment of changes in cutaneous cephalic and extracephalic tactile pain sensitivity, using von Frey monofilaments. Sensitivity to headache/migraine triggers was tested by examining the effect of intraperitoneal administration of a low dose of glyceryl trinitrate (100 µg/kg). Treatments included acute systemic administration of sumatriptan (1 mg/kg) and repeated systemic administration of a mouse anti-calcitonin gene-related peptide monoclonal antibody (30 mg/kg). Serum levels of calcitonin gene-related peptide were measured at baseline and at various time points post head injury in new cohorts of females (n = 38) and males (n = 36). Results Female rats subjected to a mild closed head injury developed cutaneous mechanical hyperalgesia, which was limited to the cephalic region and was resolved 4 weeks later. Cephalic pain hypersensitivity was ameliorated by treatment with sumatriptan but was resistant to an early and prolonged treatment with the anti-calcitonin gene-related peptide monoclonal antibody. Following the resolution of the head injury-evoked cephalic hypersensitivity, administration of glyceryl trinitrate produced a renewed and pronounced cephalic and extracephalic pain hypersensitivity that was inhibited by sumatriptan, but only partially by the anti-calcitonin gene-related peptide treatment. Calcitonin gene-related peptide serum levels were elevated in females but not in males at 7 days post head injury. Conclusions Development of post-traumatic headache-like pain behaviors following a mild closed head injury, and responsiveness to treatment in rats is sexually dimorphic. When compared to the data obtained from male rats in the previous study, female rats display a prolonged state of cephalic hyperalgesia, increased responsiveness to a headache trigger, and a poorer effectiveness of an early and prolonged anti-calcitonin gene-related peptide treatment. The increased risk of females to develop post-traumatic headache may be linked to enhanced responsiveness of peripheral and/or central pain pathways and a mechanism independent of peripheral calcitonin gene-related peptide signaling.

Reversible cerebral vasoconstriction syndrome developing after an erenumab injection for migraine prevention

Cephalalgia ◽  
2021 ◽  
pp. 033310242110372
Author(s):  
Todd D Rozen ◽  
Alok A Bhatt
Keyword(s):  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Illicit Drugs ◽  
Calcitonin Gene Related Peptide ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Related Peptide ◽  
Cerebral Vasoconstriction ◽  
Calcitonin Gene ◽  
Preventive Medication ◽  
New Type

Background Reversible cerebral vasoconstriction syndrome is normally triggered by vasoactive compounds or illicit drugs. A new type of migraine preventive medication blocks calcitonin gene-related peptide utilizing monoclonal antibodies. Calcitonin gene-related peptide is a potent vasodilator for the cerebrovascular system. Could blocking calcitonin gene-related peptide be a trigger for cerebral artery vasospasm in patients susceptible to developing reversible cerebral vasoconstriction syndrome (migraine patients) or in individuals using vasoactive compounds? We present a case of reversible cerebral vasoconstriction syndrome occurring after calcitonin gene-related peptide monoclonal antibody treatment. Case report A 43-year -old woman with a history of episodic migraine developed an acute headache with orgasm two days after taking her second injection of erenumab. Ten days after erenumab injection she developed a thunderclap headache while completing a high intensity workout. These new headaches were only left sided. Computed tomography angiography demonstrated mild to moderate areas of narrowing involving the left middle and anterior cerebral arteries, concerning for reversible cerebral vasoconstriction syndrome. She denied exposure to any known reversible cerebral vasoconstriction syndrome precipitant medication or illicit drugs. She did endorse recent exposure to high altitude prior to erenumab therapy. She was started on verapamil 40 mg three times per day and her headache ceased within 24 h of initiating treatment. A repeat CT angiogram completed 4 weeks after the initial study noted resolution of the areas of vessel stenosis. Conclusion A case of reversible cerebral vasoconstriction syndrome developing after treatment with a calcitonin gene-related peptide monoclonal antibody is presented. The timing of the new type of headache occurring 2 days post erenumab injection suggests a possible cause and effect relationship. Reversible cerebral vasoconstriction syndrome as a possible treatment-related complication to the usage of calcitonin gene-related peptide monoclonal antibodies needs to be studied further.

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